1    does not cause insulin release

2    may provoke lactic acidosis

3    requires monitoring of renal function


A    1, 2, 3

B    1, 2 only

C    2, 3 only

D    1 only

E    3 only


  1. A is the answer and the winners are Otiegha and Solace.
    Metformin is a biguanide which, unlike sulphonylureas, is not associated with
    weight gain. It is therefore an appropriate antidiabetic for GL who is obese.
    It increases insulin sensitivity and increases the utilisation of glucose. It does
    not interfere with insulin release. It may cause lactic acidosis. During treatment
    metformin causes conversion of glucose to lactate in the intestinal mucosa;
    lactate is transported to the liver where it is normally metabolised. High plasma
    concentrations of metformin such as in renal impairment or high lactate
    concentrations in blood caused by liver disease and alcohol abuse lead to the
    inability by the liver to clear the lactate. Metformin should not be used in renal
    impairment, and diabetic patients receiving metformin should have their renal
    function monitored to exclude renal function deterioration, which may warrant
    withdrawal of metformin.


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